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SUBCLINICAL HYPOTHYROID. MANAGING PATIENTS USING RESTING METABOLIC RATE AND BRACHIORADIALIS REFLEXOMETRY Dr. Konrad Kail 480-905-9200 [email protected] GENERAL CONSIDERATIONS. MUST WORK FOR HUMANS TO FUNCTION ABSORPTION AND ASSIMILATION DETOXIFICATION AND ELIMINATION REGULATION

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Subclinical hypothyroid l.jpg

SUBCLINICAL HYPOTHYROID

MANAGING PATIENTS USING

RESTING METABOLIC RATE

AND

BRACHIORADIALIS REFLEXOMETRY

Dr. Konrad Kail

480-905-9200

[email protected]


General considerations l.jpg
GENERAL CONSIDERATIONS

  • MUST WORK FOR HUMANS TO FUNCTION

    • ABSORPTION AND ASSIMILATION

    • DETOXIFICATION AND ELIMINATION

    • REGULATION

  • STRESS IMPACTS ALL OF THESE BUT THE MOST PROFOUND AND IMMEDIATE EFFECT IS ON REGULATION

    • ADRENAL AND THYROID GLANDS ARE THE MOST STRESS LABILE

  • ADRENAL AND THYROID INTERACT IN REGULATING

    • WEIGHT

    • ENERGY

    • BLOOD SUGAR

    • BLOOD FATS

    • NEUROTRANSMITTERS

    • SEX HORMONES

    • INFLAMMATION

    • IMMUNE FUNCTION


Organ reserve l.jpg
ORGAN RESERVE

SUPPORT

ORGAN

RESERVE

Degeneration

STRESSORS


Thyroid feedback regulation l.jpg

The production of thyroid hormone is controlled by a feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4.

The thyroid gland uses

L-Tyrosine and Iodine to make T4, the storage form of thyroid hormone and T3 the active form

Thyroid Feedback Regulation


Subclinical hypothyroid5 l.jpg
SUBCLINICAL HYPOTHYROID feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4.

  • SYMPTOMS COMPATIBLE WITH HYPOTHYROID (> 12 on Symptom Survey)

  • LOW BBT (< 97.5o F axillary)

  • SLOW REFLEXES (> 137 msecs)

  • LOWER RMR

  • NORMAL TO SLIGHTLY HIGH TSH

  • NORMAL FREE T3, FREE T4

  • NORMAL T3U, T4, T7

  • PREVALENCE UNKNOWN (8-30%)


Cardiovascular risk l.jpg
CARDIOVASCULAR feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4.RISK

  • INCREASED

    • SERUM LIPIDS

    • HOMOCYSTEINE

    • C-REACTIVE PROTEIN

    • CORONARY HEART DISEASE

    • HYPERTENSION

    • ISCHEMIC HEART DISEASE

    • ENDOTHELIAL DAMAGE

    • COAGUABILITY

    • PERIPHERAL ARTERY DISEASE

  • DECREASED

    • STROKE VOLUME

    • CARDIAC OUTPUT

MARKERS OF

SUDDEN DEATH

RISK


Diabetes risk l.jpg
DIABETES RISK feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4.

  • DISRUPTION OF GLP-1 SIGNALLING

  • DECREASED THYROID FUNCTION UP TO 18 HOURS AFTER HYPOGLYCEMIC EPISODES

  • ASSOCIATED WITH INSULIN RESISTANCE

    INCREASED

  • HOMA AND TRIG/HDL

  • DYSGLYCEMIA

  • OBESITY


Arthritis inflammation l.jpg
ARTHRITIS & INFLAMMATION feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4.

  • INCREASED RATES OF HASHIMOTO’S

  • INCREASED EUTHYROID SICK RISK

  • RA PATIENTS WITH SUBCLINICAL HYPOTHYROID HAD DYSFUNCTIONS OF GLUCOSE METABOLISM AND INSULIN RESISTANCE


Neuro psychological risk l.jpg
NEURO-PSYCHOLOGICAL RISK feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4.

INCREASED

  • HOFFMAN’S SYNDROME

    • WEAKNESS AND STIFFNESS

  • DUPUYTREN’S CONTRACTURE

  • CARPAL TUNNEL SYNDROME

  • POLYMYOSITIS-LIKE SYNDROME

  • PARKINSONS

  • HEARING LOSS

  • ANXIETY AND DEPRESSION

  • 1.97 RELATIVE RISK OF COGNITIVE DECLINE (ALZHEIMER’S)


Bone risk l.jpg
BONE RISK feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4.

INCREASED

  • BONE RESORPTION IN HYPERTHYROID

    • URINARY PYRIDINOLINE

    • URINARY DEOXYPYRIDINOLINE

    • URINARY CALCIUM

    • SERUM TELOPEPTIDES

  • NO CALCIUM METABOLISM PROBLEMS IN HYPOTHYROID

    • CALCIUM BINDS THYROID

      (TAKE THYROID AT LEAST 45 MINS AWAY FROM CALCIUM)


Pregnancy l.jpg
PREGNANCY feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4.

  • FERTILITY ISSUES

  • 3 FOLD INCREASE IN PLACENTA PREVIA

  • 2 FOLD INCREASE IN PREMATURE DELIVERY

  • MAY AFFECT MENTATION IN OFFSPRING

    • NOT WELL STUDIED


Factors affecting thyroid function l.jpg
FACTORS AFFECTING feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4.THYROID FUNCTION

  • PERIPHERAL CONVERSION OF T4 TO T3

    • HEPATIC, RENAL, MITOCHONDRIAL FUNCTION

    • DECREASED 5’D-1

      • INHIBITED BY IL-1, IL-6

  • TOXIC MATERIALS

    • LEAD, MERCURY

    • PCB

    • FUNGICIDES, ORGANO-CHLORINE INSECTICIDES

  • DRUGS

    • AMIODORONE, ANTI-CONVULSANTS, SALSALATE, LITHIUM

  • MITOCHONDRIAL PROTEIN LEAKAGE

    • UNCOUPLING PROTEIN 3

  • CYTOKINES

    • NF-KAPPA-B

    • TNF-ALPHA

    • IL-1 ALPHA/BETA

  • EUTHYROID SICK SYNDROME IMPAIRS FUNCTION UP TO 60 DAYS FOLLOWING ACUTE SEVERE ILLNESS


  • Slide13 l.jpg

    DISTRIBUTION feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4.OF THYROID


    Slide14 l.jpg

    DECREASED CONVERSION feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4.


    Slide15 l.jpg

    REVERSE T3 (RT3) feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4.


    Vasoactive intestinal peptide and thyroid function l.jpg
    Vasoactive Intestinal Peptide and Thyroid Function feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4.

    • VIP exerts action through 2 receptors VPAC1 and VPAC2

      • VPAC1 receptors are in liver, breast, kidney, prostate, ureter, bladder, pancreatic ducts, GI mucosa, lung, thyroid, adipose tissue, lymphoid tissue, and adrenal medulla.

      • VPAC2 receptors are in blood vessels, smooth muscles, the basal part of mucosal epithelium in colon, lung, and vasculature of kidney, adrenal medulla and retina. Also present in thyroid follicular cells and acinar cells of the pancreas.

    • In hypothyroid, there was a 2-fold increase in all peptides derived from VIP, found in the gastric fundus

    • In hypothyroid significant increases of pituitary VIP

    • VIP modulates T3 and T4 (decreases) in any inflammation


    De iodinases l.jpg
    DE-IODINASES feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4.

    BiancoAC, Salvatore D, et al. Biochemistry, cellular and molecular biology,

    and physiological roles of the iodothyronine selenodeiodinases. Endocr Rev. 2002

    Feb;23(1):38-89.

    T4 to T3 CONVERSION

    ACTION ON METABOLISM


    Thyroid receptor phenotypes l.jpg
    Thyroid Receptor Phenotypes feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4.

    Alkemade A, Vujist CL, et al. Thyroid hormone receptor expression in the human

    hypothalamus and anterior pituitary. J Clin Endocrinol Metab. 2005 Feb;90(2):904-12.

    T4 to T3 Conversion

    Action on Metabolism


    Tsh regulation l.jpg
    TSH- REGULATION feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4.

    MAY NOT REPRESENT METABOLIC DEMAND


    Nutrients and thyroid l.jpg
    NUTRIENTS AND THYROID feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4.

    • SELENIUM

      • IMPROVES FUNCTION DECREASES RECOVERY TIME IN EUTHYROID SICK SYNDROME

    • IRON AND ZINC

      • INCREASE THYROID FUNCTION IN IRON/ZINC DEFICIENT

      • NO EFFECT IN IRON/ZINC SUFFICIENT

    • CALCIUM

      • INHIBITS ABSORPTION

    • ALPHA-TOCOPHEROL

      • NO EFFECT

    • KELP AND ALL IODINE

      • HELPFUL IN IODINE DEFICIENT

      • DOSE DEPENDENT DECREASE IN THYROID FUNCTION IF IODINE SUFFICIENT

    • L-CARNITINE DECREASESTHYROID FUNCTION

      • PREVENTS THYROID HORMONE ENTRY INTO NUCLEUS OFCELLS

    • High Soy intakeinhibits thyroid function

      • Ipriflavone helps bone resorption but does not increase cancer risk


    Lithium and thyroid function l.jpg
    Lithium and Thyroid Function feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4.

    • Enters thyrocyte via the Na+/I- Symporter

    • Concentrated in thyroid gland to 3-4 times serum levels

    • Increases intra-thyroidal iodine content

    • Inhibits coupling of iodotyrosine residues

    • Decreases colloid droplet formation

    • Inhibits microtubule formation

    • Inhibits thyroid hormone secretion

    • Blocks iodine release from thyroid gland

    • Treats hyperthyroid in people allergic to iodine


    Iodine uptake and retention l.jpg
    Iodine Uptake and Retention feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4.

    Symporter

    Iodine, Lithium

    (Retention)

    mitochondria

    ATP

    I-

    I-

    I-

    Thyroid peroxidase

    H2O2

    TSH Iodine

    (trapping)

    TG

    Proteolysis

    T4 T3

    Iodinated TG

    Colloid Resorption

    T4

    ECF

    Colloid

    T3


    Slide23 l.jpg

    HPT AXIS feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4.

    HPA AXIS

    STRESS

    HYPOTHALAMUS

    HYPO

    HYPER

    HYPOTHALAMUS

    TRH

    ZINC

    CRH

    CRH

    ADAPTOGENS

    INHIBITS

    SNS

    PITUITARY

    PITUITARY

    TSH

    ACTH

    ACTH

    INHIBITS

    THYROID

    SELENIUM, VIT D

    IODINE +/-

    ADRENAL CORTEX

    MEDULLA

    SELENIUM, ZINC, VIT E,

    ASWAGANDA

    RT3

    T4

    INHIBITS

    GLUCOCORTICOIDS

    (CORTISOL)

    GLUCOCORTICOIDS

    (CORTISOL)

    5’DEIODINASE

    T3

    CATECHOLAMINES

    (EPINEPHRINE, NOREPINEPHRINE, ALDOSTERONE)

    Hypercortisolemia Inhibits Thyroid Function


    Influence of other hormones on thyroid activity l.jpg
    Influence of Other Hormones feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4.on Thyroid Activity

    HERTOGHE, T; The Hormone Handbook. International Medical Books

    Surrey, UK, 2006, p88.


    Hypothyroid causes adrenal dysfunction l.jpg
    Hypothyroid Causes feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4.Adrenal Dysfunction

    • Results in hypersecretion of CRH and AVP from hypothalamus

    • Significantly increased pituitary content of VIP

    • ↓ Adrenal weight, ↓ Corticosterone

    •  ACTH, CRH, AVP

      Tohei A. Studies on the functional relationship between thyroid, adrenal and gonadal hormones. J Reprod Dev 2004 Feb;50(1):9-20.


    Measurements of thyroid function l.jpg
    MEASUREMENTS feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4. OF THYROID FUNCTION

    SERUM MEASUREMENTS

    • What’s on the shelves at the pharmacy

    • TSH INSENSITIVE WHEN APPROACHING NORMAL

      PHYSIOLOGIC MEASUREMENTS

    • What you took home from the pharmacy

  • BODY MASS INDEX

    • CORRELATION WITH RESTING METABOLIC RATE

  • BASAL BODY TEMPERATURES

    • IDENTIFY SUBCLINICAL HYPOTHYROID

    • TOO SLOW TO RESPOND TO TREATMENT

  • RESTING METABOLIC RATE

    • SOME ARTIFACTS

      • CONGESTION

      • REACTIVE AIRWAY DISEASE

      • ASTHMA OR OTHER COPD

  • REFLEXES

    • ACHILLES, BRACHIORADIALIS, STAPEDIAL

    • NO ARTIFACTS UNLESS NERVE DAMAGE


  • Methodology l.jpg
    METHODOLOGY feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4.

    • ENTRY CRITERIA

      • BBT<97.50 F AXILLARY AVERAGE (BRODA BARNES)

    • BASELINE MEASUREMENT AND THIRTY DAY TREATMENT INTERVALS

      • SYMPTOM SURVEY

      • BODY MASS INDEX

      • RESTING METABOLIC RATE (oxygen consumption)

      • BRACHIORADIALIS REFLEXOMETRY (mean of 4)

      • TSH,T3U, T4, T7

        • ADDED FREE T3, FREE T4

        • SOME HAD

          • MICROSOMAL (TPO) AB

          • THYROGLOBULIN AB

          • REVERSE T3

          • THYROTROPIN RELEASING HORMONE

      • LIPIDS

        • CHOLESTEROL

        • LDL

        • HDL

        • TRIGLYCERIDES


    Slide28 l.jpg

    RESTING METABOLIC RATE feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4.

    MEASUREMENT VIA OXYGEN

    CONSUMPTION


    Slide29 l.jpg

    PROTO-TYPE BRACHIORADIALIS REFLEXOMETRY SYSTEM feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4.


    Slide30 l.jpg

    INCLUDES feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4.

    COMPUTER

    Hammer

    Link

    Inclinator


    Slide31 l.jpg

    Hammer Strike feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4.

    Pre-fire

    Interval

    Fire

    Interval

    Euthyroid


    Slide32 l.jpg

    Pre-Fire feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4.

    Fire

    HYPOTHYROID


    Slide33 l.jpg

    Prefire Interval feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4.

    Fire Interval

    Hyperthyroid


    Slide34 l.jpg

    NORMAL = .052 to 0.137 SECS feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4.

    NORMAL


    Slide35 l.jpg

    NORMAL = .052 to 0.137 SECS feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4.

    Borderline


    Kail waters equation l.jpg
    KAIL-WATERS EQUATION feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4.

    RMR = 2307.62 + [-7.53(CM)] + [27.09(KG)] + [-42.59(BMI)] + [-45.47(PREFIRE)] + [45.85(FIRE)] +

    [-46.27(FIRE-PREFIRE)]


    Predicted vs measured rmr l.jpg
    PREDICTED vs MEASURED RMR feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4.


    Worst to best 1 st cohort l.jpg
    WORST TO BEST feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4.1st Cohort


    Why tsh does not identify those at risk l.jpg
    WHY TSH DOES NOT IDENTIFY feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4.THOSE AT RISK !!!

    TSH gets too low before adequate effect (RMR)

    Patients that became normal by reflexes and symptoms had a mean RMR increase of about 400 kcals

    N=100

    TSH <0.3

    FIRE-PREFIRE<66


    Slide43 l.jpg

    <0.3 n = 109 feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4.

    0.3-0.5 n = 5

    0.5-4.5 n = 146

    >4.5 n = 22


    Predictability of brachioradialis reflex testing l.jpg
    PREDICTABILITY OF BRACHIORADIALIS REFLEX TESTING feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4.


    Predictability of brachioradialis reflex testing45 l.jpg
    PREDICTABILITY OF BRACHIORADIALIS REFLEX TESTING feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4.


    Sensitivity l.jpg
    SENSITIVITY feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4.

    Sensitivity is the proportion of those that are hypothyroid that are correctly diagnosed.

    It is expressed as:

    ________True Positives_______ = __117__ = 0.992

    True Positives + False Negatives 117 + 1


    Specificity l.jpg
    SPECIFICITY feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4.

    Specificity is the proportion of those that are euthyroid that were correctly identified.

    It is expressed as:

    ________True Negatives_______ = ___58___= 0.906

    True Negatives + False Positives 58 + 6


    Predictive value of positive test l.jpg
    PREDICTIVE VALUE feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4.of POSITIVE TEST

    Predictive Value of a Positive Test is the proportion of those with a positive test that are hypothyroid.

    It is expressed as:

    ________True Positives_______ = ___117__= 0.951

    True positives + False Positives 117+6


    Predictive value of negative test l.jpg
    PREDICTIVE VALUE feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4.of NEGATIVE TEST

    Predictive Value of a Negative Test is considered the proportion of those with a negative test who are euthyroid:

    It is expressed as:

    _______True Negatives_______ = ___58____= 0.983

    False Negatives + True Negatives 1 + 58


    How to optimize thyroid activity and treatment l.jpg
    HOW TO OPTIMIZE feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4.THYROID ACTIVITY AND TREATMENT

    HERTOGHE, T; The Hormone Handbook. International Medical Books

    Surrey, UK, 2006, p87.


    Otc thyroid agents l.jpg
    OTC THYROID AGENTS feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4.


    Homeo and rmr l.jpg
    HOMEO AND RMR feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4.

    Had to consume too many doses per day to maintain effect

    n=5

    n=5

    n=2

    n=1


    Otc thyroid and rmr l.jpg
    OTC THYROID AND RMR feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4.

    Had to consume too many doses to maintain effect

    n=4

    n=3

    n=5


    Tissue and cofactors and rmr l.jpg
    TISSUE AND COFACTORS feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4. AND RMR

    KELP

    IODINE

    n=4

    n=7

    n=3

    n=6

    n=1


    Rx thyroid preparations l.jpg
    RX THYROID PREPARATIONS feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4.


    Symptom score worst to best l.jpg
    SYMPTOM SCORE feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4.WORST TO BEST


    Rmr response to medication l.jpg
    RMR Response to Medication feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4.


    Slide58 l.jpg
    RMR feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4.


    Prefire normal l.jpg
    PREFIRE NORMAL feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4.

    1STVD= 20.72

    N = 281

    Normal 70-153


    Fire normal l.jpg
    FIRE NORMAL feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4.

    1 STVD = 26.80

    N = 281

    NORMAL 152-259


    Fire prefire normal l.jpg
    FIRE-PREFIRE NORMAL feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4.

    1 STVD = 21.24

    N = 281

    NORMAL 52-137


    Reflex parameters l.jpg
    REFLEX PARAMETERS feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4.

    n=281

    n=101

    n=281

    n=14


    Change in bbt 2 nd cohort l.jpg
    CHANGE IN BBT feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4.2nd Cohort


    Change in weight 2 nd cohort l.jpg
    CHANGE IN WEIGHT feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4.2nd Cohort


    Change in bmi 2 nd cohort l.jpg
    CHANGE IN BMI feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4.2nd Cohort


    Hyperthyroid signs l.jpg
    HYPERTHYROID SIGNS feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4.

    • PALPITATIONS 6:815 0.7%

    • TACHYCARDIA 4:815 0.4%

    • SHAKEY/HYPER 2:815 0.2%

    • HAIR LOSS 1:815 0.1%

    • HYPERTENSION 1:815 0.1%

    • TOTAL 14:815 1.7%


    Sonora quest normals l.jpg
    SONORA QUEST NORMALS feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4.


    Slide68 l.jpg
    TSH feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4.

    < 66 msecs

    52-137 msecs


    At target fire prefire 66 l.jpg
    AT TARGET feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4.(FIRE-PREFIRE<66)


    At target rmr change 355 l.jpg
    AT TARGET feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4.(RMR CHANGE >355)


    Dessicated thyroid and serum thyroid hormones l.jpg
    DESSICATED THYROID AND SERUM THYROID HORMONES feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4.


    Change in serum hormones 2 nd cohort l.jpg
    CHANGE IN SERUM HORMONES feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4.2nd Cohort

    STAYED IN NORMAL RANGE


    Hashimoto s and rmr l.jpg
    HASHIMOTO’S AND RMR feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4.

    ANTIBODIES STILL HIGH

    30 DAYS AFTER


    Reflexes and hashimoto s l.jpg
    REFLEXES AND HASHIMOTO’S feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4.

    30 DAYS AFTER


    Hashimoto s and tsh l.jpg
    HASHIMOTO’S AND TSH feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4.

    ANTIBODIES NOT RECOGNIZING

    (BINDING) NEW MED

    ANTIBODIES STILL HIGH

    30 DAYS AFTER


    Thyroid effects on serum lipids l.jpg
    THYROID EFFECTS ON feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4.SERUM LIPIDS

    SIMILAR TO A STATIN DRUG

    N=30


    Adapting thyroid dose to environment l.jpg
    ADAPTING THYROID DOSE feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4.TO ENVIRONMENT

    HERTOGHE, T; The Hormone Handbook. International Medical Books

    Surrey, UK, 2006,p89.


    Cost of thyroid meds l.jpg
    COST OF THYROID MEDS feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4.

    Many on synthetic thyroid require both T3 and T4

    Combination Therapy $82.60 for 30 day supply


    Thyroid myths l.jpg
    THYROID MYTHS feedback loop. When there is not enough receptor site activity in the hypothalamus, TRH is elaborated which stimulates the anterior pituitary to make TSH, which then stimulates the thyroid to make more T3 and T4.

    • DOES SUBCLINCAL HYPOTHYROID NEED TO BE TREATED ?

      • HEALTH RISK IS HUGE IF UNTREATED

    • IS TSH THE BEST CLINICAL MARKER ?

      • INSENSITIVE NEAR NORMAL

        • GETS TOO SMALL BEFORE FULL CLINICAL EFFECT

      • RECEPTOR ACTIVITY DOESN’T REFLECT METABOLIC DEMAND

    • IS IODINE GOOD FOR THYROID FUNCTION ?

      • DECREASES THYROID FUNCTION IF NOT DEFICIENT

    • ARE SYNTHETIC THYROID MEDS MORE PRECISE AND MORE SCIENTIFIC THANNATURAL ?

      • NATURAL THYROID IS BIOIDENTICAL, U.S.P. AND HAS > EFFECT

      • HALF-LIFE IS LONG IN MOST THYROID MEDS

      • MOST PEOPLE END UP ON 2 SYNTHETIC MEDS

        • IF SYNTHROID ALONE CAN’T CONVERT T4 TO T3

        • IF CYTOMEL ALONE T4 GOES TO ZERO


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